Adolescent Scoliosis

Scoliosis is a side-to-side curve in the back. Adolescent idiopathic scoliosis (AIS) occurs at age 10 or later. It may start at puberty or during a growth spurt in the teens.

Symptoms

AIS is most often discovered during a routine physical exam. Pain is not typical in teens with AIS, but if it occurs, more investigation should be done. AIS symptoms include:

One shoulder appears higher than the other

Clothes do not hang straight

Fatigue in the lower back after sitting or standing a long time

Muscle aches in the back

These X-rays (at right) show the frontal and side view and the abnormal curvatures caused by scoliosis.

Causes and Risk Factors

Females are at higher risk than males. Six to eight out of every 10 cases involve girls. Two to three percent of children between the ages of 10 and 16 have detectable AIS.

Diagnosis

A physical examination will indicate that the curve of the spine is more obvious when the child or teen bends forward. Most often the spine curves to the right in the upper back and to the left in the lower back, causing the right shoulder to be higher than the left. One hip may be more prominent than the other. X-rays taken at various angles while the child or teen is standing will also reveal the curves of the back.

Treatments

As early as possible after the condition has been diagnosed, the child or teen should be seen by a spine specialist. Treatment is directed at preventing more deformity, using a cast or brace or surgical correction.

Non-operative care, such as back braces, may be helpful in the early stages for a curvature of less than 45 degrees. Curvatures of greater than 45 to 50 degrees must be treated with surgery to keep the heart and lungs working properly over time. Surgical techniques include:

Minimally invasive correction of scoliosis

Endoscopic thoracic release

Spinal fusion with instrumentation

Outcomes will depend on where and how much the spine curves and how old the individual was when the symptoms appeared. The greater the curve, the greater the chance that the curving of the spine will get worse after the person's bones mature.

This condition and its treatment may interfere with a teen's self-image. Wearing a brace may cause self-consciousness. The teen's primary doctor should work with the spine specialist for diagnosis, counseling about treatment options and dealing with adjustment issues.